In an Arthritis Care & Research study of individuals who underwent total knee replacement, those who did not attend college had worse pain and function after two years if they lived in poor communities, but educational level was not linked with pain or function in wealthy communities.

How education might protect those in impoverished communities warrants further study.

“This study illustrates the complex ways that social factors interact, and the importance of analyzing contextual factors,” said lead author Dr. Susan Goodman, of Weill Cornell Medicine in New York City.